April 8, 2017
The relationship between vitamin C dosage and its effects on the duration of the common cold symptoms may extend to 6-8 grams per day according to a statistical analysis published in Nutrients.
Dozens of animal studies using different animal species have found that vitamin C significantly prevents and alleviates infections caused by diverse bacteria, viruses, and protozoa. Given the universal nature of the effect of vitamin C against various infections in different animal species, it also seems evident that vitamin C influences the susceptibility to, and the severity of infections in humans. However, the practical importance of vitamin C in human infections is not known.
The common cold is the most extensively studied infection regarding the effects of vitamin C. The majority of controlled trials have used a modest dosage of only 1 g per day of vitamin C. The pooled effect of all published studies has shown a statistically highly significant difference between the vitamin C and placebo groups, which indicates a genuine biological effect. However, the optimal doses and the maximal effects of vitamin C on the common cold are unknown. The trials that used doses higher than 1 g per day usually found greater effects than trials with exactly 1 g per day, which suggests a dose dependent effect. Nevertheless, definitive conclusions cannot be made from such a comparison because of numerous confounding differences between the trials. The most valid examination of dose-response is therefore within a single trial that has randomly selected trial groups with different vitamin C doses, so that exposure to viruses is similar and the outcome definition is identical in the study groups.
Dr. Harri Hemilä from the University of Helsinki, Finland, analyzed the findings of two randomized trials each of which investigated the effects of two vitamin C doses on the duration of the common cold. The first trial administered 3 g/day vitamin C to two study groups, 6 g/day to a third group, and the fourth group was administered a placebo. Compared with the placebo group the 6 g/day dose shortened colds by 17%, twice as much as the 3-g/day doses did.
The second trial administered 4 g/day and 8 g/day vitamin C, and placebo to different groups, but only on the first day of the cold. Compared with the placebo group, the 8 g/day dose shortened colds by 19%, twice as much as the 4 g/day dose did. Both studies revealed a significant dose-response relationship between the vitamin C dosage and the duration of the common cold. The dose-response relationship in these two trials was also linear up to the levels of 6-8 g/day, thus it is possible that even higher doses may lead to still greater reductions in the duration of common cold. Dr. Hemilä notes that there have been proposals that vitamin C doses should be over 15 g/day for the best treatment of colds, but the highest doses that have so far been investigated in randomized trials have been much lower.
Dr. Hemilä concludes that "given the consistent effect of vitamin C on the duration of colds, and its safety and low cost, it would be worthwhile for individual common cold patients to test whether therapeutic 8 g/day vitamin C is beneficial for them. Self-dosing of vitamin C must be started as soon as possible after the onset of common cold symptoms to be most effective." Dr Hemilä also states that further therapeutic trials should be carried out to investigate the dose-response relation in the region of over 8 g/day of vitamin C.
April 7, 2017
Type 2 diabetes is a serious health concern in the United States and across the globe. New research shows that a high consumption of legumes significantly reduces the risk of developing the disease.
The legume family consists of plants such as alfalfa, clover, peas, peanuts, soybeans, chickpeas, lentils, and various types of beans.
As a food group, they are believed to be particularly nutritious and healthful. One of the reasons for this is that they contain a high level of B vitamins, which help the body to make energy and regulate its metabolism.
Additionally, legumes are high in fiber and contain minerals such as calcium, magnesium, and potassium. They also comprise a variety of so-called phytochemicals - bioactive compounds that further improve the body's metabolism and have been suggested to protect against heart disease and diabetes.
Finally, legumes are also considered to be a "low glycemic index food," which means that blood sugar levels increase very slowly after they are consumed.
To make people aware of the many health benefits of legumes, the year 2016 has been declared the International Year of Pulses by the Food and Agriculture Organization of the United Nations. Pulses are a subgroup of legumes.
Because of their various health benefits, it has been suggested that legumes protect against the onset of type 2 diabetes - a serious illness that affects around 29 million people in the U.S. and more than 400 million adults worldwide. However, little research has been carried out to test this hypothesis.
Therefore, researchers from the Unit of Human Nutrition at the Universitat Rovira i Virgili in Tarragona, Spain, together with other investigators from the Prevención con Dieta Mediterránea (PREDIMED) study, set out to investigate the association between legume consumption and the risk of developing type 2 diabetes in people at an increased risk of cardiovascular disease.
The study also analyzes the effects of substituting legumes with other foods rich in proteins and carbohydrates, and the findings were published in the journal Clinical Nutrition.
The team investigated 3,349 participants in the PREDIMED study who did not have type 2 diabetes at the beginning of the study. The researchers collected information on their diets at the start of the study and every year throughout the median follow-up period of 4.3 years.
Individuals with a lower cumulative consumption of legumes had approximately 1.5 weekly servings of 60 grams of raw legumes, or 12.73 grams per day. A higher legume consumption was defined as 28.75 daily grams of legumes, or the equivalent of 3.35 servings per week.
Using Cox regression models, the researchers analyzed the association between the incidence of type 2 diabetes and the average consumption of legumes such as lentils, chickpeas, dry beans, and fresh peas.
Overall, during the follow-up period, the team identified 266 new cases of type 2 diabetes.
The study revealed that those with a higher intake of legumes were 35 percent less likely to develop type 2 diabetes than their counterparts who consumed a smaller amount of legumes. Of all the legumes studied, lentils had the strongest association with a low risk of type 2 diabetes.
In fact, individuals with a high consumption of lentils (defined as almost one weekly serving) were 33 percent less likely to develop diabetes compared with their low-consumption counterparts - that is, the participants who had less than half a serving per week.
Additionally, the researchers found that replacing half a serving per day of legumes with an equivalent portion of protein- and carbohydrate-rich foods including bread, eggs, rice, or potatoes also correlated with a reduced risk of diabetes.
The authors conclude that:
"A frequent consumption of legumes, particularly lentils, in the context of a Mediterranean diet, may provide benefits on type 2 diabetes prevention in older adults at high cardiovascular risk."
April 6, 2017
There is no doubt among clinicians that the risk of cardiovascular disease in people with diabetes is very high. Even many of us with type 2 diabetes are aware of this. And in all patients with cardiovascular risks, based on past medical history or the family tree, it is accepted that once-daily low dose aspirin is an important measure in reducing this risk. This is especially important in the diabetes population where, even without a family history, cardiovascular complications run high.
Yet, there is a segment of the population who display “resistance” to the antiplatelet effectsof low dose aspirin. Noncompliance due to untoward effects, such as GI distress and bleeding events, is certainly one explanation for aspirin failure, but it does not explain this issue in patients who indeed take their doses every day.
It is recognized that the antiplatelet effects of aspirin are due to inhibition of cyclooxygenase-1 (COX-1(an enzyme that regulates prostaglandins (Fatty acids with local hormone-like and other effects. They occur in most tissues.) that are important for the health of the stomach lining and kidneys; "an unfortunate side effect of NSAIDs is that they block Cox-1")), which is responsible for the formation of prostaglandins as well as the platelet aggregation effects of thromboxane (TX - Any of several compounds, originally derived from prostaglandin precursors in platelets, that stimulate aggregation of platelets and constriction of blood vessels).
Aspirin’s effects on COX-1 are dose dependent, with low doses (81-325 mg daily) showing preferential inhibition of TX formation. It is this suppression that imparts aspirin’s cardio protective effect. Over time, some have suggested that aspirin failure may be in part due to enteric coatings or selected dose, especially in people with diabetes who have been shown to overcome “resistance” with increased dosing, it could be counterproductive to achieving cardio protection due to inhibition of vascular dilating prostacyclins, and the occurrence of adverse effects. With regard to coated versus regular aspirin, there has been some variability in aspiring bioavailability in enteric-coated products, although no large scale studies have been performed. To further muddy the waters, the pharmaceutical company PLx Pharma developed PL2200, a lipid-based aspirin capsule, which was approved by the FDA in 2012 under the name PL-Aspirin. A study was recently released comparing the effects of three aspirin formulations on thromboxane activity, as well as their absorption properties, in obese diabetic subjects.
This was a single site, randomized active control, single-blinded (all study staff), triple-crossover (all subjects received all tested drugs), pharmacokinetic and pharmacodynamic study, utilizing three products, immediate release aspirin, enteric-coated aspirin, and PL2200 aspirin. Subjects were ages 21-79, obese with BMI 30-40, no cardiovascular history, had insulin dependent type 2 diabetes. Study drug was given as a single dose once weekly for 3 weeks. Baseline platelet function was obtained within 3 hours of administration of each study drug. Measured data included serum TX, serum salicylic acid and acetylsalicylic acid, and platelet aggregation. Complete aspirin responsiveness was indicated by at least 99% TXB2 inhibition over baseline, or a non-adjusted measurement up to 3.1 ng/ml. Non-responsiveness was the absence of one or both of the responsiveness criteria.
Forty subjects met enrollment criteria, with five subjects had to drop out prior to completion. With regards to a complete aspirin response, time to achieve 99% inhibition of TXB2 was obtained for all 3 products: PL2200 12.5 ± 4.6 hrs, plain aspirin 16.7 ± 4.6 hrs, and enteric-coated aspirin 48.2 ± 4.6 hrs. Both PL2200 and plain aspirin showed significantly faster inhibition time than enteric-coated aspirin (p less than 0.0001 for both comparisons), where no significant difference was seen between PL2200 and plain aspirin (p=0.41). The incidence of non-responsiveness was: PL2200=8.1%, plain aspirin=15.8%, and coated aspirin=52.8%. Again, the differences between PL2200 or plain aspirin when compared to coated aspirin were significant (p less than 0.0001 for both comparisons), but not significant between PL2200 and plain aspirin (p=0.63). Plasma aspirin concentration profiles were similar between PL2200 and plain aspirin, with a slower time to peak and decreased AUC for coated aspirin. Recovery of platelet activity was similar with all three formulations. A post-hoc analysis showed females to have a higher risk of non-responsiveness (p=0.0414), while all other variables were not shown to be independent predictors.
In this small study, the comparisons of aspirin pharmacokinetics and pharmacodynamics clearly favor PL2200 and plain aspirin over enteric-coated aspirin. The authors purport that enteric-coated aspirin has a clinically significant reduction in absorption, which lends an explanation to treatment failure. While PL2200 and plain aspirin are considered equivalent with regard to measured outcomes, PL2200 may be favorable due to tolerance. One of the negitives is that PL2200 contains phosphatidylcholine, which has shown to increase arherosclerosis. However, the exclusion of subjects with cardiovascular history, non-obese subjects, and the lack of chronic administration studies may limit the findings of this study. Furthermore, several of the investigators have ties to PLx Pharma, which lends a strong degree of bias. As always, further studies on this subject are warranted.
Enteric-coated aspirin displays diminished absorption compared to other aspirin formulations, which may lower its effectiveness in cardiovascular prophylaxis.
April 5, 2017
We know that the numbers of people diagnosed with type 2 diabetes is increasing rapidly in the United States, but in the United Kingdom, type 2 diabetes numbers have trebled in the last 20 years. According to Cardiff University, the number of people with type 2 diabetes in the UK went from 700,000 to about 2.8 million.
The good news in the data collected by general physicians between 1991 and 2014 showed an increase in life expectancy for those with type 2 diabetes.
Between 1993 and 2010, the proportion of obese people across the UK doubled from 13% to 26% for men. That figure went from 16% to 26% for women.
Wales has the highest prevalence of diabetes in the UK, with 7.1% of people aged 17 and over living with the condition, Diabetes Cymru UK has said.
Rates of the type 2 form of the disease continue to rise, according to Professor Craig Currie from Cardiff University's school of medicine.
He added the increased life expectancy finding could be due to earlier diagnosis of the condition, as well as drugs such as blood pressure tablets and statins for blood cholesterol.
The research also revealed the prevalence of type 2 diabetes increased with age, although this increase is lower in people aged 80 years and above. Prevalence was also generally higher in men than in women above the age of 40.
Around 90% of the 4.5 million people who live with diabetes in the UK have type 2 diabetes.
This form of the disease develops when the insulin-producing cells in the body are unable to produce enough insulin, or when the insulin that is produced does not work properly.
It is treated with a healthy diet, increased physical activity, medication and insulin.
April 4, 2017
A new measurement technique may lower daily vitamin D recommendation. I say may – because it hasn't been proven yet, but is just listed as a new measurement technique. A claim is made that it is now the gold standard, but there are questions.
After re-measurement of vitamin D by improved technology, the Recommended Dietary Allowance (RDA) for vitamin D intake drops from 800 to 400 International Units (IU) per day, new research reports. The results of the study will be presented Sunday, April 2, at ENDO 2017, the annual scientific meeting of the Endocrine Society, in Orlando, Florida.
"The RDA is easily achievable with a supplement of 400 IU in winter, when vitamin D levels are lowest in North America," said principal investigator J. Christopher Gallagher, M.D., professor and director of the Bone Metabolism Unit in the Division of Endocrinology of Creighton University School of Medicine in Omaha, Nebraska.
"This has important ramifications for public health recommendations. The amount of vitamin D needed, 400 IU daily, is less than the figure recommended by Institute of Medicine," said Gallagher, the study's principal investigator.
"In estimating the RDA for vitamin D intake, the laboratory method used for measuring serum 25-hydroxyvitamin D ? 25(OH)D ? can affect the results," he said. "The estimated RDA based on the older immunoassay (DiaSorin S.p.A., Salugia, Italy) system was 800 IU daily, whereas the newer liquid chromatography tandem-mass spectrometry (LC-MS/MS) technique estimated that 400 IU daily would meet the RDA."
In their earlier double-blind dose-response clinical trial in the winter and spring of 2007 to 2008, Gallagher and his colleagues enrolled 163 healthy postmenopausal Caucasian women 57 through 90 years of age with vitamin D insufficiency and followed them for 1 year. The women were at least 7 years postmenopausal and they had vitamin D insufficiency based on the World Health Organization cutoff (serum 25(OH)D 20 ng/ml or lower).
The participants were randomized to one of seven vitamin D3 doses: 400, 800, 1600, 2400, 3200, 4000, 4800 IU/day or placebo, for 1 year, and all the women were given calcium supplements to maintain a total calcium intake. After analyzing the samples and estimating the RDA using the older immunoassay, the authors reported that 800 IU daily would meet the vitamin D intake requirement for 97.5 percent of the population.
But now that liquid chromatography mass spectrometry (LC-MS/MS) has become the gold standard for measuring 25(OH)D, the researchers have reanalyzed the original samples using this new technology. Able to determine a more precise dose-response curve, they have calculated the RDA for vitamin D to be 400 IU daily.
"Remember, this RDA is for bone health only," Gallagher cautioned. "It may be different for other diseases. Although trials looking into cancer, diabetes, and other diseases are ongoing, we do not have information about this yet."
It will be interesting to see whether the Institute of Medicine agrees with the new measurement technique and government agencies agree.
April 3, 2017
Vitamin D is an important micronutrient with major health benefits, including improved immunity and stronger bones. There is also mounting evidence that it could help you lose weight.
Vitamin D is a fat-soluble vitamin that you can get from vitamin D-rich foods or supplements. Your body is also able to make it through sun exposure. Vitamin D is essential for maintaining strong bones and teeth, keeping your immune system healthy and facilitating the absorption of calcium and phosphorus.
Because vitamin D is not found naturally in very many foods, most health professionals recommend getting at least 5–30 minutes of sun exposure daily or taking a supplement to meet the recommended daily amount of 600 IU (15 mcg).
Unfortunately, vitamin D deficiency affects nearly 50% of people worldwide.
Those at risk of deficiency include (2):
- Older adults
- Breastfed infants
- Dark-skinned individuals
- Those with limited sun exposure
Obesity is another risk factor for deficiency. Interestingly, some evidence suggests that getting enough vitamin D could help with weight loss.
Studies show that a higher body mass index and body fat percentage are associated with lower blood levels of vitamin D. Several different theories speculate about the relationship between low vitamin D levels and obesity. Some claim that obese people tend to consume fewer vitamin D-rich foods, thus explaining the association. Others point to behavioral differences, noting that obese individuals tend to expose less skin and may not be absorbing as much vitamin D from the sun.
Certain enzymes are needed to convert vitamin D into its active form, and levels of these enzymes may differ between obese and non-obese individuals. However, a 2012 study noted that once vitamin D levels in obese individuals are adjusted for body size, there’s no difference between levels in obese and non-obese individuals. This indicates that your vitamin D needs depend on body size, meaning obese individuals need more than normal-weight people to reach the same blood levels. This could help explain why obese people are more likely to be deficient.
Interestingly, losing weight can also affect your vitamin D levels. In theory, a reduction in body size would mean a decrease in your vitamin D requirement. However, since the amount of it in your body remains the same when you lose weight, your levels would actually increase.
And, the degree of weight loss may affect the extent to which its levels increase.
One study found that even small amounts of weight loss led to a modest increase in blood levels of vitamin D. Furthermore, participants who lost at least 15% of their body weight experienced increases that were nearly three times greater than those seen in participants who lost 5–10% of their body weight.
Moreover, some evidence shows that increasing vitamin D in the blood can reduce body fat and boost weight loss.
Some evidence suggests that getting enough vitamin D could enhance weight loss and decrease body fat. At least 20 ng/mL (50 nmol/L) is considered an adequate blood level to promote strong bones and overall health. One study looked at 218 overweight and obese women over a one-year period. All were put on a calorie-restricted diet and exercise routine. Half of the women received a vitamin D supplement, while the other half received a placebo.
At the end of the study, researchers found that women who fulfilled their vitamin D requirements experienced more weight loss, losing an average of 7 pounds (3.2 kg) more than the women who did not have adequate blood levels.
Another study provided overweight and obese women with vitamin D supplements for 12 weeks. At the end of the study, the women didn’t experience any weight loss, but they did find that increasing levels of vitamin D decreased body fat.
Vitamin D could also be associated with a decrease in weight gain. A study in over 4,600 elderly women found that higher levels of vitamin D were linked to less weight gain between visits during the span of the 4.5-year study. Based on these studies, it seems that the weight-related benefits of vitamin D come from increasing its blood levels, rather than supplementation itself.
Several theories attempt to explain vitamin D’s effects on weight loss. Studies show that vitamin D could potentially stop the formation of new fat cells in the body. It could also prevent the storage of fat cells, effectively reducing fat accumulation.
Additionally, vitamin D can increase levels of serotonin, a neurotransmitter that affects everything from mood to sleep regulation. Serotonin may play a role in controlling your appetite and can increase satiety, reduce body weight and decrease calorie intake.
Finally, higher levels of vitamin D may be associated with higher levels of testosterone, which could trigger weight loss. A 2011 study gave 165 men either vitamin D supplements or a placebo for one year. It found that those receiving the supplements experienced greater increases in testosterone levels than the control group.
Several studies have shown that higher levels of testosterone can reduce body fat and help sustain long-term weight loss. It does this by boosting your metabolism, causing your body to burn more calories after eating. It could also block the formation of new fat cells in the body.
It’s recommended that adults 19–70 years old get at least 600 IU (15 mcg) of vitamin D per day. However, supplementing with vitamin D may not be a “one size fits all” approach, as some research indicates that the dosage should be based on body weight. One study adjusted vitamin D levels for body size and calculated that 32–36 IU per pound (70–80 IU/kg) is needed to maintain adequate levels.
Vitamin D supplements can cause toxicity when consumed in large amounts. It’s best to consult your doctor before exceeding the upper limit of 4,000 IU per day.
It’s clear there’s an intricate relationship between vitamin D status and weight.
Getting enough vitamin D can keep your hormone levels in check and may help enhance weight loss and decrease body fat.
In turn, losing weight can increase vitamin D levels and help you maximize its other benefits, such as maintaining strong bones and protecting against illness.
If you get limited exposure to the sun or are at risk of deficiency, it may be a good idea to consider taking supplements. Supplementing with vitamin D may help keep your weight under control and optimize your overall health.
April 2, 2017
Yes, we know all about “April Fools” jokes; however it was decided to have a meeting anyway and then possibly another on April 29. And, we had a new CDE (Beverly) to welcome back to the group. And then we had an even larger surprise when Beverly also announced that we had a new CDE as a member. None of us knew that Jennifer was in the program and had been accepted as a Certified Diabetes Educator.
This brought a round of applause that surprised many of us, but was welcomed as well. Brenda asked both to stand up front and accept a congratulation line. This took some time, but everyone went forward to congratulate both of them.
Then Brenda asked both of them to speak briefly to the group. Jennifer started by saying she was happy that there were two of us. She said that when she needed support she had found it in our group. She thanked Brenda, Sue, and Beverly and then asked Beverly to thank Suzanne or give her an address so she could send a thank you card.
Beverly said she would give her an address later. She said the hospital had used both of them for diabetes education and this had allowed for better results for more patients. Jennifer was nodding her head. Beverly said that there would be another nurse/CDE about next April that would also work in the hospital.
At that point, Brenda said Beverly would have the program about foot care and avoiding amputation.
Beverly thanked me for the many blogs I had written about foot care and avoiding amputation. She said that most people only think of amputation involving the feet and lower legs, but she said that she was surprised recently by an arm amputation. The person entered the emergency department with gangrene in the hand and half way to the elbow. She continued that normally people go to the doctor for anything not healing in the hand or arm so this was a real surprise when it came time for the amputation.
Beverly said they average five to eight toe, foot, or partial leg amputations per month and she said that everyone here should check their feet daily or ask someone to check them for you if you are unable or don't have a mirror to see the bottom of each foot.
Next, she asked for a show of hands from those that see a podiatrist at least quarterly. Of the 26 present, only 13 of us did see one quarterly. She next asked if there were some that saw one more or less often. Four more hands were raised. She asked each how often and all said twice a year. Then she asked how many had mirrors to check their feet and six more hands were raised. She asked how the other three were handling checking their feet and all said they were able to look at the bottom and Sue and Bob said they also help each other at times.
She then asked Brenda to include the three blogs of mine, blog 1 on avoiding amputations, blog 2 on foot care, and blog 3 also on foot care in the newsletter she sent out, as they were important.
Then Beverly opened for questions and the discussion lasted another half an hour. Then cleanup was done and the meeting was over.